Intracoronary ultrasound-guided stenting improves outcomes: A metaanalysis of randomized trials

Abstract

Background: Intracoronary ultrasound (IVUS) has been used as an adjunctive method in order to optimize implantation of stents. However, the impact of this method in some outcomes is controversial. Objective: To systematically review the impact of routine IVUS-guided coronary stent as compared to angiographic-guided, on clinical and angiographic outcomes. Methods: A search of databases (MEDLINE, Cochrane CENTRAL, EMBASE) and references of published studies, from 1982 to 2010, was conducted. Randomized clinical trials (RCTs) that compared angiography plus IVUS-guided (IVUS) vs. angiography alone guided (ANGIO) coronary stent implantation were included. Minimum follow-up was 6 months and the outcomes assessed were major adverse cardiac events (MACE), target lesion revascularization (TLR) and angiographic restenosis. Two reviewers independently extracted the data. Summary risk ratio and 95% confidence intervals (CI) were calculated with random-effects models. The GRADE approach was used to determine the overall quality of evidence for each outcome. Results: Out of 3,631 articles identified, 8 RCTs evaluating a total of 2,341 patients were included. There was a 27% reduction in angiographic restenosis (95%CI: 3%-46%) and a 38% reduction in TLR (95%CI: 17%-53%) in favor of IVUS vs. ANGIO. However, MACE were not reduced by IVUS (RR: 0.79; 95%CI: 0.61-1.03). The MACE data represent only 47% of the optimal information size required to reliably detect a plausible treatment effect. Conclusions: We observed that IVUS-guided coronary stenting provides significant reductions in TLR and angiographic restenosis compared to angiographically-guided stenting, but it does not reduce MACE.